kpoliroadrace.mypay.com.np
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103.90.85.80
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URL:
https://kpoliroadrace.mypay.com.np/
Submission: On March 18 via api from US — Scanned from US
Submission: On March 18 via api from US — Scanned from US
Form analysis
1 forms found in the DOMPOST https://kpoliroadrace.mypay.com.np/contacts
<form action="https://kpoliroadrace.mypay.com.np/contacts" method="POST" enctype="multipart/form-data" onsubmit="disableSubmitButton()">
<input type="hidden" name="_token" value="Df8tL5ru4uSjSDUPuu6OQjq2M3ffGqrB5NZKPU6r">
<div class="row mt-4">
<div class="col-lg-12">
<input type="hidden" name="device" id="deviceType" value="PC">
<div class="mb-3">
<label class="form-label">Full Name <span class="text-danger">*</span></label>
<div class="form-icon position-relative">
<svg xmlns="http://www.w3.org/2000/svg" width="24" height="24" viewBox="0 0 24 24" fill="none" stroke="currentColor" stroke-width="2" stroke-linecap="round" stroke-linejoin="round" class="feather feather-user fea icon-sm icons">
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</svg><input name="name" id="name" type="text" class="form-control ps-5" placeholder="Your Full Name" maxlength="48">
</div>
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<div class="col-lg-12">
<div class="mb-3">
<label class="form-label">Address <span class="text-danger">*</span></label>
<div class="form-icon position-relative">
<svg xmlns="http://www.w3.org/2000/svg" width="24" height="24" viewBox="0 0 24 24" fill="none" stroke="currentColor" stroke-width="2" stroke-linecap="round" stroke-linejoin="round" class="feather feather-map-pin fea icon-sm icons">
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</svg><input name="address" id="address" type="text" class="form-control ps-5" placeholder="Your Full Address" maxlength="200">
</div>
</div>
</div>
<div class="col-md-12">
<div class="mb-3">
<label class="form-label">Email Address <span class="text-danger">*</span></label>
<div class="form-icon position-relative">
<svg xmlns="http://www.w3.org/2000/svg" width="24" height="24" viewBox="0 0 24 24" fill="none" stroke="currentColor" stroke-width="2" stroke-linecap="round" stroke-linejoin="round" class="feather feather-mail fea icon-sm icons">
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<polyline points="22,6 12,13 2,6"></polyline>
</svg>
<input name="email" id="email" type="text" class="form-control ps-5" placeholder="Your Email Address" maxlength="90">
</div>
</div>
</div>
<div class="col-md-6">
<div class="mb-3">
<label class="form-label">Contact Number <span class="text-danger">*</span></label>
<div class="form-icon position-relative">
<svg xmlns="http://www.w3.org/2000/svg" width="24" height="24" viewBox="0 0 24 24" fill="none" stroke="currentColor" stroke-width="2" stroke-linecap="round" stroke-linejoin="round" class="feather feather-smartphone fea icon-sm icons">
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<line x1="12" y1="18" x2="12.01" y2="18"></line>
</svg>
<input name="phone" id="phone" type="text" class="form-control ps-5" placeholder="Your Contact No" maxlength="16">
</div>
</div>
</div>
<div class="col-md-6">
<div class="mb-3">
<label class="form-label">Emergency Contact Number <span class="text-danger">*</span></label>
<div class="form-icon position-relative">
<svg xmlns="http://www.w3.org/2000/svg" width="24" height="24" viewBox="0 0 24 24" fill="none" stroke="currentColor" stroke-width="2" stroke-linecap="round" stroke-linejoin="round" class="feather feather-phone fea icon-sm icons">
<path
d="M22 16.92v3a2 2 0 0 1-2.18 2 19.79 19.79 0 0 1-8.63-3.07 19.5 19.5 0 0 1-6-6 19.79 19.79 0 0 1-3.07-8.67A2 2 0 0 1 4.11 2h3a2 2 0 0 1 2 1.72 12.84 12.84 0 0 0 .7 2.81 2 2 0 0 1-.45 2.11L8.09 9.91a16 16 0 0 0 6 6l1.27-1.27a2 2 0 0 1 2.11-.45 12.84 12.84 0 0 0 2.81.7A2 2 0 0 1 22 16.92z">
</path>
</svg>
<input name="contact" id="contact" type="text" class="form-control ps-5" placeholder="Your Emergency Contact No" maxlength="16">
</div>
</div>
</div>
<div class="col-md-6">
<div class="mb-3">
<label class="form-label">Blood Group <span class="text-danger">*</span></label>
<div class="form-icon position-relative">
<svg xmlns="http://www.w3.org/2000/svg" width="24" height="24" viewBox="0 0 24 24" fill="none" stroke="currentColor" stroke-width="2" stroke-linecap="round" stroke-linejoin="round" class="feather feather-droplet fea icon-sm icons">
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</svg>
<input name="blood" id="blood" type="text" class="form-control ps-5" placeholder="Your Contact No" maxlength="13">
</div>
</div>
</div>
<div class="col-md-6">
<div class="mb-3">
<label class="form-label">Age <span class="text-danger">*</span></label>
<div class="form-icon position-relative">
<svg xmlns="http://www.w3.org/2000/svg" width="24" height="24" viewBox="0 0 24 24" fill="none" stroke="currentColor" stroke-width="2" stroke-linecap="round" stroke-linejoin="round" class="feather feather-star fea icon-sm icons">
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</svg>
<input name="age" id="age" type="text" class="form-control ps-5" placeholder="How Young Are You" maxlength="22">
</div>
</div>
</div>
<div class="row">
<div class="form-check form-check-inline">
<div class="mb-0">
<div class="form-check">
<input class="form-check-input" type="checkbox" name="delicate" id="delicateCheckbox" onchange="toggleButton()">
<label class="form-check-label" for="flexCheckDefault2">I consent to MyPay collecting and storing my personal data.</label>
</div>
</div>
</div>
<div class="col-md-12">
<!-- Assuming this is inside a form element -->
<button type="submit" id="quoteButton" class="btn btn-warning btn-lg w-100" disabled="">Submit</button>
</div>
</div>
<script>
function toggleButton() {
const checkbox = document.getElementById("delicateCheckbox");
const quoteButton = document.getElementById("quoteButton");
quoteButton.disabled = !checkbox.checked;
}
function disableSubmitButton() {
const quoteButton = document.getElementById("quoteButton");
quoteButton.disabled = true;
}
function validateForm() {
const checkbox = document.getElementById("delicateCheckbox");
if (!checkbox.checked) {
alert("Please consent to the privacy policy before submitting.");
return false; // Prevent form submission
}
return true; // Allow form submission
}
// Function to detect device type and set the hidden field value
function detectDeviceType() {
const deviceTypeField = document.getElementById("deviceType");
// Check if the user is on a PC
if (window.innerWidth > 992) {
deviceTypeField.value = "PC";
}
// Check if the user is on a tablet
else if (window.innerWidth > 600) {
deviceTypeField.value = "Tablet";
}
// Otherwise, assume the user is on a mobile device
else {
deviceTypeField.value = "Mobile";
}
}
// Call the detectDeviceType function when the page loads
window.addEventListener("load", detectDeviceType);
</script>
</div>
</form>
Text Content
KP OLI ROAD RACE - 2024 Run the scenic routes, feel the adrenaline, and make memories that last a lifetime! Join us for an unforgettable running experience! EVENT VENUE : CHARPANE TO SUKHANI (10KM) Full Name * Address * Email Address * Contact Number * Emergency Contact Number * Blood Group * Age * I consent to MyPay collecting and storing my personal data. Submit SCAN TO DOWNLOAD OR Download APP Version 3.0.4 * * *